MEDICAL STAFF DEVELOPMENT

Medical staff development is a concept usually associated with hospitals and medical centers who value the doctors on the staff as the "distribution arm" for system related products and services. The cultivation of a strong and loyal medical staff is recognized as a key to the survival of the hospital as a viable economic entity. However, the emphasis is now shifting to approaches which quantify each component of the medical staff to rank their impact and value. The answer is no longer a simple "more is better." The new question is which departments or doctors might make the most substantial contribution relative to the attainment or acquisition cost?

Medical staff development for the group practice is even more critical than it is for a hospital since the size and composition of the group is directly related to revenue development. The preservation of product lines, key segments of the patient base and even entire departments might be related to one or two key physicians. Mortality and morbidity risk is more pronounced because a group usually has a less diverse base than that of a hospital, yet group practices seldom have a formal planning process for the preservation, enhancement and improvement of their key component resource -- the doctor. This paper attempts to outline the key factors in the planning process and indicators which might be referenced by the physicians as they initiate this process.

The following points are offered as a discussion guide to assist the planner in prioritizing the medical staff development investment. In the end analysis, the balance between investment, risk and return is the key to good business development. Hopefully, this approach will result in an orderly discussion of a critical topic for health care organizations.

• A medical staff development plan should be structured to assure the continuation of the present service level to the community.



• Replacements for doctors approaching retirement age or anticipating a marked reduction in contribution levels should be recruited.
• Existing departments, franchises, patient groups, or areas which are underserved should be staffed.



• A medical staff development plan should develop business from presently controlled patient bases.



• Referrals to outside subspecialists should be quantified and, when absolute numbers indicate feasibility, the subspecialty should be internalized by the group.
• Referrals lost due to geographic or institutional issues should be quantified and, when feasible, liaisons with groups or doctors represented in those areas or entities should be formalized.
• Consults by hospital-based physicians or doctors who are aligned with procedural or diagnostic units not owned by the group should be studied and, when appropriate, the business should be converted to fall under group control.

• A medical staff development plan should address perceived needs of the physician group members relative to quality of care or quality of practice.



• Physician members should be polled to determine their perception of need for back-up, quality controls, coverage, accessibility, coordination, patient continuity, service levels, etc. Where there is a consensus, the board should consider recruiting to fill these perceived needs.
• Internal utilization studies, cross referral patterns, quality and efficiency reviews, etc., should be analyzed. Where deficiencies occur which negatively affect the group and its patients, or which undermine the overall mission, there may be indication for board action which results in recruiting.

• A medical staff development plan should anticipate market opportunities and address the competitive nature of the health care catchment area.

• An analysis of need in the community should be conducted to highlight product lines, geographic locations, services, etc., which represent targets of business or service opportunity for the group. If practical, after risk and investment have been considered, the group should address these needs through the medical staff development process.
• Referral patterns to subspecialties external to the market area should be analyzed to assess the feasibility of local provision of care as an improved service.
• Competitors should be routinely studied to determine opportunities for improved competitive positions, collaboration or acquisition. Special notice should be taken of those practices which might be anticipating change themselves.



• A medical staff development plan should accommodate liaisons, affiliations, collaborative ventures and joint ventures. It should support referral arrangements with other entities and physician groups.



• Referral patterns into the group from external practices should be identified and quantified. There should be a component of the plan which supports and enhances these practitioners.
• Opportunities for cooperation with other noncompetitive entities should be identified and pursued. The board may pursue formal (or informal) relationships developed with supportive providers in addition to, or in lieu of, direct recruiting.

Medical staff planning cannot be accomplished in a vacuum. The trends in a group must be studied along with the trends of competitors and those in the community. Any plan must address compliance with regulatory issues which were undefined even a few years ago. These include national and state sanctions relating to STARK regulations, antitrust, fraud and abuse, etc. If the entity is a nonprofit, issues relating to inurement must be considered.

In summary, a medical staff development plan is derived from a process which is both qualitative and quantitative. There are basic financial aspects involved as well as philosophical and social implications. An effective plan is a diagram for strategic action and a program which should improve the income and the equity position of each corporate member while offering stability to the health care entity.

For more information on this topic or additional material concerning Medical Staff Planning, please contact Mike La Penna of the La Penna Group at (800) 527-3662.

We would also welcome your comments and questions by E-Mail at mlapenna@lapenna.com. Thank you for visiting our site.